Emergency marginal ulcer surgery post-RNY

[On Feb 2, I edited the subject since the content is about the emergency surgery and the ulcer; causes being alcohol, tobacco, NSAIDS; so a new title seemed better]

Ok, as I alluded to in yesterdays menu post, I had a medical emergency last week and it could very much pertain to many of you on the board, so I want to share.

The super fast TL;DR on me is: I am a 45 year old woman, I had RNY ten years ago, I was a champion loser who went from highest 369/ surgery weight 350 to?160. In just over a year. I then got a lower body lift, breast lift and arm lift, and was loving my new life.

Looking back, I was inching up a bit in weight in 2017/2018 (I had moved in with my partner and stepkids, meals changed etc) and in august of 2018 I hit 200 lbs. Well that should have been the red alarm but for whatever reason it wasn?t. And I still felt good and was active so I somehow ignored it. Like ignoring it will help.

I know this sounds insane (even to me) but my MyFitnessPal records show I just didn?t weigh myself in 2019. Wtaf? So when the world shut down I did, and in Spring 2020 I was 235 lbs. I was so ashamed (still am). The pandemic was really hard on me as an outgoing extrovert for whom travel is a huge source of joy, and I was working too much, and drinking too much, and gyms were closed, but somehow I maintained right around that weight for the last 3 years. I saw pics and didn?t like what I saw, but I never had the motivation and I wasn?t making the right choices to make a change.

Last Monday, I woke up with a stomachache. Not normal for me, but no big deal. I went and sat on the toilet. Suddenly I had SEARING pain move up to my sternum to my chest and my left shoulder and arm. I was convinced I was dying of a heart attack.

I freaked out. I called 911 and had a heart catherization which showed my heart was good and my arteries were wide and flowing well. But a CT scan showed an ulcer had burst and I had a PERFORATED HOLE in my stomach and food and gas had leaked into my abdominal cavity. I had emergency surgery to repair the hole and clean out my body - sepsis is common and the mortality rate is quite high. I was in ICU until Wed night and I wasn?t allowed to eat or drink anything. Then I moved to a regular room and they put in a PICC line for me to have IV antibiotics at home for 3 weeks ? before discharging me Saturday evening. I have seven new incisions across my abdomen.

Here?s why this pertains to you, RNY board (if you read this far!):

I had a chronic marginal ulcer with perforation which is a common late complication after gastric bypass surgery. A marginal ulceration (MU) is defined as ulcers at the margins of the gastrojejunostomy, mostly on the jejunal side. Most marginal ulcers respond to medical therapy and complicated or complex ulcer disease warrants operative intervention; specifically, perforated, penetrated, obstructing, bleeding and intractable marginal ulcers require surgical intervention.

According to my doctor, while I would like to wholly blame the stress of my job on this ulcer, while stress is a contributing factor, the main causes are ALCOHOL, tobacco, and NSAIDS.

I will freely admit I have a very stressful job and during the pandemic and beyond I was self-soothing with wine. I am certainly not calling anyone out but I see many of my virtual friends here doing the same - and I get it! Long, stressful day, large pour of Pinot noir?ahhh, relaxing. Well, all those relaxing nights put me in the hospital, almost killed me, and are certainly going to take at least 1-2 paychecks to pay off ?

I?m not saying don?t drink or really telling anyone what to do! I just want to share what happened with me in case it makes you think.

I asked if I should have yearly CT scans and my surgeon said they wouldn?t help. He wants me to follow up with a gastroenterologist in six months to be sure it?s healing well and likely do a yearly scope going forward.

I?ll tell you what, the pain last week, and knowing I almost died, scared me ****less.

Here is a little more information I found from the Interwebs. Feel free to holler (or DM) with questions - I?m an open book ??

Most MUs are managed medically but those with complications like bleeding or perforation require intervention.

From what I?ve read, with the rising number of Roux en-Y gastric bypasses performed around the world, general surgeons should expect to face an equally rising number of early- and late-term complications. Marginal or anastomotic ulcers constitute the majority of these cases, representing as many as 52 percent of postoperative complications. Marginal ulceration is a challenging problem, which can cause significant morbidity in the postoperative bariatric patient. Its etiology remains elusive and perhaps multifactorial, including both exogenous and intrinsic or technical factors. In addition, while prevention is key, it is often difficult to achieve. While most of these types of ulcers do respond to medical therapy, there is a select group of patients that continues to suffer from symptomatic, nonhealing ulcers, despite appropriate medical treatment, and requires surgical intervention. The current body of literature does not contain a great deal on the subject of optimal surgical management for marginal ulcers intractable to medical therapy, perhaps a reflection of marginal ulcers? unclear etiology.

Thank you for sharing your experience. This is why I love this board, we are all on the same boat and we learn from each other.
Fast healthy jujus and enjoy moving up to the next level. I feel like as long as I can have coffee I can deal with rest.

It's unthinkable to imagine losing you!!!!

I am so happy that you took your symptoms seriously and that you are putting out the call to all of us to examine what behaviors we might be doing that seem so innocent--an Advil here... a glass of wine there... But they add up, and I for one and going to heed your call and really try to reign in my lazy attitude and get back on track.

I appreciate you for a million reasons, but your willingness to be an open book is one of them. XOXO

I understand the ulcer diagnosis but where is the chronic component identified? Have you ulcer issues previously or symptoms treated with a ppi? I know a lot of programs treat for that initially (mine didn't) so I'm curious if yours did? Obviously the antibiotics are for the serious infection risk but do you have to take anything for the ulcer?

Thank you for sharing your experience and doctor recommendations, we can all learn something from each other's experience.

Also, just as a side note, it doesn't sound like the regain you are beating yourself up about had anything to do this this health crisis so focusing on this recovery (and treatment) should be first along with not beating yourself up - you can't do anything today about if you did/didn't weigh yourself 4 years ago! So just get healthy and then focus on your next steps to health.

Great questions, Jen! I have never had ulcers that I've known of, nor been treated. I've never had to take an antacid or any pill or anything.

In the hospital I got Protonix in the IV and the doctor prescribed me one per day for the next year. Though, depending on my scope in six months, the dosage could go up or down.

You are exactly right - the regain was just due to too many calories (both food and wine!) and this liquid diet is certainly helping me reset back to what I should be eating to nurture my body in the most healthful way ð?'?

Emily, how utterly terrifying. Sepsis is no joke and you are lucky to be here to tell your story.

Thank god you got the life saving surgery and are recovering. I hope you can truly take time to heal your body, mind & soul.

I know we don't talk anymore but I wish you nothing but amazing health ahead and lots of soul lifting travel in your future when you can go Globe trotting again.

Take good care of you, so glad you are here!

BIG LOVE

Big love back to you, Daisy!!! Im sure as a nurse you can relate to how terrifying and possibly deadly this was. I've honestly never felt the pain and fear of last Monday before, and don't ever want to again!

I always know I've got you in my corner and I'm in yours as well. You and hubs and the puppers all look like you're doing amazing You should be so proud of yourself for your ongoing success. We all know losing the weight is the easiest part, keeping it off...that's the hardest!

Sending international smooches!

Omg - how scary! So glad you are okay, Emily!!!

I am so sorry you went through this!

I have been tempted to take NSAIDs so I needed to read this. Thank you so much!

Thanks so much for enlightening us. I am certainly aware there can be complications but always felt secure being 5 years out. Did you experience any aches or pains prior to the emergency? I remember pre surgery them saying I had reflux yet I never had heartburn so I thought they were just diagnosing it to get my insurance to pay for WLS. Is there anything we could do for early detection? I'm so glad you're on a mend and you came back here to share. I'll cheer you on every step of the way. I look forward to the day you win your battle. Hang in there. Proud of you.